The number of Americans adopting children abroad is steadily increasing. So, too, is the demand for doctors specialized in treating children from diverse health and cultural backgrounds.

Nurse Christine Narad watches four-year-old Lian's reactions, as they play together in the doctor's office. Her adoptive mother talks about Lian's adjustment to her new brothers and sister.

Lian arrived in the Washington area two months ago from China. Her new mom, Donna Josephs, had taken Lian to her family pediatrician, but wanted another opinion.

"My pediatrician is not that experienced in adoption, and I wanted to make sure we didn't miss anything, and make sure her skills are okay," she explains.

So Mrs. Josephs brought Lian to the INOVA hospital's International Adoption Center in Fairfax, Virginia. It is one of a dozen centers across the United States specializing in treating children adopted from other countries.

"The children that are coming from around the world, really come with a different set of issues and exposures," said Dr. Mason. "There are a number of infections unique to a child from Russia or China or Central America that a pediatrician in the United States may not be used to seeing."

Dr. Mason will also test Lian for lead poisoning, because of the widespread use of lead-based paint in China. He said doctors not familiar with international adoption might overlook that.

Mrs. Josephs also wanted to check if Lian was carrying any infectious disease, such as Tuberculosis or parasites, which her regular pediatrician may not have focused on.

Pediatricians with a growing expertise in adoption medicine also focus on stress problems and developmental delays that may result from lengthy stays in orphanages, especially in Eastern Europe, Russia and Ukraine. Many children in impoverished countries in Europe, Asia and Latin America are left at orphanages by parents who cannot afford to care for them.

When kids are living in group settings, they're more at risk for more contagious illnesses," explains Dr. Sarah Springer, who heads the Mercy Center for International Adoption Medicine in Pittsburgh, Pennsylvania. "In many institutional care settings, children don't get enough food or attention, and their development is delayed. And they come here with a number of nutritional needs and delays, and cognitive and social skill delays that can be long lasting and unique, that most pediatricians wouldn't see."

Dr. Springer heads the American Academy of Pediatricians' adoption medicine sub-specialty, which was created two years ago.

The idea of a separate category for adoption medicine, she said, started germinating some 20 years ago, with two Midwest doctors who themselves had adopted children.

As it becomes easier for Americans to adopt children overseas, the demand for specialized doctors increases.

Last year, the U.S. State Department registered more than 18,000 international adoptions, double the total seven years ago. China, Russia, South Korea, Romania and Guatemala account for three-fourths of the total.

Pediatrician Patrick Mason started focusing on adoption medicine five years ago as a natural progression from his studies of child stress and development issues. He is currently researching delayed child development in Romanian orphanages.

Dr. Mason said parents now are seeking out specialized pediatricians to answer health questions, even before the adoption is completed.

"Often the families will come home, having [information about] a child identified by the adoption agency, and will have medical information and videos, and we can review the tapes and medical records and give them an idea of potential strengthens and problems of the child they are adopting," he explains.

Dr. Springer, of the American Academy of Pediatrics, sees the adoption doctor as a valuable source of information and support.

"What I view my role [as] - and I think we all view it this way, is to help families sort out what definite needs a child will have," said Dr. Springer, "and what potential needs, to foresee, to help them sort out if they can meet those needs."

Dr. Springer says international adoption clinics are also providing a network of medical specialists, including foreign-born doctors, who can add a cultural sensitivity to their treatment.